We report on a case of a large atypical cartilaginous tumor of the pelvis and its novel surgical resection with an anterior hemipelvectomy and reconstruction with an iliac crest graft. Surgical intervention is the mainstay treatment of pelvic chondrosarcomas. However, there have been reports of concern regarding preventing pelvic visceral herniation and adequately reconstructing the pelvis. This report is unique within the literature and has yielded good functional outcomes whilst achieving satisfactory surgical margins and minimizing morbidity.

Giant cell tumour of bone (GCTOB) is a relatively uncommon, benign, but locally aggressive neoplasm. Denosumab is a fully human monoclonal antibody with inhibitory effects on receptor activator of nuclear factor kappa‐B ligand that has shown early promise as a possible treatment adjuvant for GCTB. However, much is still unknown about its current indications, long‐term effects, the potential risk for rapid relapse and its involvement in sarcomatous transformation.

Aims As the population ages, there is projected to be an increase in the level of demand for total knee arthroplasty (TKA) in octogenarians. We aimed to explore whether those aged ≥ 80 years achieved similar improvements in physical function to younger patients while also comparing the rates of length of stay (LOS), discharge to rehabilitation, postoperative complications, and mortality following TKA in older and younger patients. Patients and Methods Patients from one institution who underwent primary elective TKA between 1 January 2006 and 31 December 2014 were dichotomized into those ≥ 80 years old (n = 359) and those < 80 years old (n = 2479) for comparison. Multivariable regression was used to compare the physical status component of the 12-Item Short-Form Health Survey (SF-12), LOS, discharge to rehabilitation, complications, and mortality between the two groups. Results Both age groups demonstrated a clinically meaningful improvement in their self-reported physical health relative to their baseline with no clinically relevant difference noted between them. Being ≥ 80 years old was associated with a 0.58-day increase in LOS and older patients were more likely to be discharged to rehabilitation (odds ratio (OR) 3.06, p < 0.001). Medical complications and mortality were higher in elderly patients (OR 1.92 for complications, p < 0.001; hazard ratio 3.40 for death, p < 0.001). There was no statistically significant association between age group and experiencing a postoperative surgical or wound-related complication. Conclusion Those aged over 80 years achieved a statistically significant lower median SF-12 physical score than the younger group, after adjusting for the preoperative score, but this difference of 4.46 was not considered to be clinically meaningful. However, clinicians should be aware that the elderly are at a higher risk of experiencing longer hospital stays, postoperative medical complications, and mortality. Cite this article: Bone Joint J 2018;100-B:1463–70.

BACKGROUND:Elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective options for the management of osteoarthritis that has not responded to conservative therapy, and they are increasing in utilization worldwide. Therefore, we sought to investigate how older age influences the outcomes of THA and TKA through a review of the current literature. METHODS:The Embase and MEDLINE databases were examined for relevant studies that assessed the role of older age in determining the outcomes of THA and TKA. All studies except for systematic reviews and case reports were considered for inclusion. Studies were excluded if they included data on procedures other than THA and TKA or if they focused on the effect of surgical techniques and rehabilitation programs rather than age. We excluded studies if they included data on total joint arthroplasty (TJA) performed for indications other than osteoarthritis unless osteoarthritis was the diagnosis for >90% of the patient cohort. Journal references were manually searched to identify any additional articles. RESULTS:Thirty-two articles were identified in this review. The most elderly groups in these studies were shown to experience higher mortality rates, more postoperative complications, and a longer stay in the hospital. Perioperative mortality was reported to be between 2.6% and 2.9% for nonagenarians and 1.09% and 1.54% for octogenarians. The increase in length of stay for the elderly following TJA was reported to be 0.6 to 3.1 days. Despite the increased rate of adverse events, there were gains in terms of pain relief and ability to perform activities of daily living, and overall the most elderly groups were satisfied with the THA or TKA. However, there was considerable inconsistency among studies with respect to the methodology for evaluating health-related quality of life and the level of functional ability postoperatively. CONCLUSIONS:Although TJA is considered an effective surgery for the elderly, clinicians should be aware that the elderly are at a higher risk of greater length of stay, complications, and mortality. However, the available literature contained poor data and heterogeneous patient cohorts, and reported on a wide variety of outcomes. Further research assessing the effect of older age on TJA is warranted.